Category Archives: Commentary

Historians, Doctors, and the History of Medicine

I assiduosly follow the listserv MEDMED-L (Medieval Medicine). The list manager is Monica Green, Professor of History at Arizona State University. Professor Green oversees a lively conversation that covers not only the history of medieval medicine, but also a general academic “take” on all matters medicohistorical. It gives me, a non-academic, insight into trends in historiography. She also posts occasional rants or pet peeves.

 In her most recent of the latter, Professor Green cites a recent blogpost in which the British classicist Helen King describes “a particularly fine case of Bad History” in a newly published medical textbook. Professor Green takes the story and runs with it, observing that a relevant piece of historical scholarship never made its way into PubMed, a definitive bibliography for medical researchers. She concludes, “So, this is what we’re up against when we’re talking about the invisibility of humanistic work. We’ve talked about this on MEDMED-L multiple times, but even with Google and Google Scholar, it seems that people simply won’t step outside of certain boundaries when it comes to bibliography”. She means that mainstream medical authors don’t do a good job of researching and understanding historical aspects of their discipline.

This state of affairs is ironic because physicians themselves “discovered” medical history in the modern west. Early in the 20th century, men like William Osler, who was classically trained, and Fielding Garrison, a pioneer in the history of military medicine, cited their history direct from Greek and Latin. Two of the most renowned mid-century historians of medicine were physicians: Henry Sigerist mastered 14 languages – including Arabic, Sanskrit and Chinese – which he applied to his study. Unfortunately, he died of a stroke long before he had completed his work. More durable was Owsei Temkin, another physician giant in the history of medicine. Russian born and German trained, Dr Temkin held forth as Professor of History of Medicine at John’s Hopkins, publishing his last book just a year before he died at 99. 

By around mid-twentieth century, PhD historians had also discovered medical history, and since that time, have come to dominate all aspects of the discipline, and justifiably so: they bring training in historical techniques, and, almost as importantly, the linguistic skills necessary to probe the ancients. That’s not to say physicians have left the field entirely. For instance, Howard Markel, MD., PhD, Professor of the History of Medicine at the University of Michigan is well known and well regarded, and has published more than 100 articles and reviews, and written or edited 10 books. Nevertheless, it’s pretty clear – despite protestations* to the contrary – that a PhD / MD divide exists in the production (and use?) of medical history. And, at least by the example cited here, MDs may not be doing such a good job of citing their own history, especially if that history is not found in the medical (vice historical) literature.

What to do? Professor Green says that relevant historical writing needs to find its way into standard medical research bibliographies. Surely, if the National Library of Medicine owns a volume, it should be listed in PubMed. In addition, medical editors should, as a matter of policy, insist that works containing historical references be subjected to rigorous peer review – by historians. Professor Green closes, I’m not sure how relevantly, “Hence the value of blogs, which erase the scholarly / popular [shall I say ‘PhD / MD”] divide.”

The perspective physicians and other medical professionals bring to the medicohistorical enterprise  lends a vitality that dry historicism cannot. Even if we don’t have the skills or inclination to research and write medical history, our most human of professions calls on us to portray it with exemplary accuracy, and I might add, with extraordinary passion.  We need to make it part of our way of thinking.

*The American Association for the History of Medicine, “a professional association of historians, physicians, nurses, archivists, curators, librarians, and others…” was founded in 1925 by a group of physicians. Some years ago, I attended the traditional Clinicians Historians’ Breakfast at an AAHM annual meeting. There, much bonhomie was generated around the importance of doctors to the medical historical enterprise. “After all, doctors create the history, and their presence provides verisimilitude to the undertaking”, people seemed to say. I’m not so sure the majority of attendees actually believed this, and I think that’s a good part of why a PhD / MD divide exists. 

On the Scurvy

It’s been a long time since I’ve posted here, and I’m sorry for that. Blame it on a very busy life, which can’t be all bad! First, a new grandbaby, born on the Ides of March, to our younger son and his wife, both in the Foreign Service, who had to come home from their posting in Azerbaijan for the happy event. Needless to say, we visited them in Baku last year – a very interesting place worth a post (but in a different blog, for sure!). The past couple of years have also seen me as Commander of the San Francisco Commandery of the Naval Order of the United States, the oldest – and a preeminent – U.S. naval history society.  My command tenure will end in December, and I’m already looking forward to doing some more writing and blogging. Here’s the first salvo—

In January, quite by chance, I came across a New York Review advertisement for a then new book, Scurvy – the Disease of Discovery by Vanderbilt University humanities chair Jonathan Lamb (Princeton University Press, 2017). I quickly added it to my Kindle library, and there, by and large, it has sat. While Professor Lamb does give an up to date description of our current scientific understanding of the cause and pathophysiology of the affliction (well known now to be due to a dietary shortage of ascorbic acid, which by some genetic fluke, humans lost the ability to synthesize many millennia ago), the book has been a slow slog for me. That’s because, at least as far as I’ve gotten into it, it’s really a history of the (non-medical) literature about the disease, made up of descriptions of the horrors of scurvy (and, strangely the “wonders” of it, too) by sufferers and observers from the 15th century forward. The author also makes some interesting side trips into, say, the history of the philosophy of science as it relates to the (mis)understanding(s) of the disease in the centuries leading up to our only relatively recent scientific insights. So far, I’m really disappointed by the author’s treatment of the history of the development of that understanding. His research on this matter seems pretty much limited to the British literature (the Dutch, French and perhaps others DID write about the disease) by way of reruns of the venerable Keevil / Lloyd & Coulter multivolume history of medicine in the Royal Navy. So nothing new here.

I plan to write a more thorough review – if ever I can successfully grind my way all the way through – really: this book is hard work! In the nonce, if any reader wishes to put forward a review earlier than that (whenever it might happen), feel free to send it to me and I’ll happily – even eagerly – post it, with appropriate attribution of course.

Technical Glitch / Learning Opportunity

Yesterday I tried to post a 38 minute video of a talk I gave on the history of Naval Hospital Mare Island, California, the Navy’s first Hospital on the west coast. The video transfer didn’t “take”, however, so back to the drawing board.

The video does appear on a Facebook page of the same name: Of Ships and Surgeons. Go take a look if you can.

Our Shrinking Historical Patrimony

I’ve posted on this topic before, noting that the ravages of time and disasters (both natural and man made) seemingly inexorably erode the historical landscape. I argued that historians should lead (or at least actively support) efforts for the preservation of historical landmarks and other artifacts.

Just recently I learned of the possible imminent demolition of such an artifact – the 1920s Spanish-revival style former Oak Knoll Country Club and Officers’ Club for the Oakland (California) Naval Hospital. 

U.S. Naval Hospital Oakland – “Oak Knoll” to Bay Area locals – sprang into existence in 1942 as part of Navy Surgeon General Ross McIntire’s massive World War 2 expansion of Navy medical facilities.* Even before war broke out McIntire, realized that the Naval Hospital at Mare Island – the Navy’s first on the west coast – was too old, too small and vulnerable to collateral damage from any Japanese air strike on the huge shipyard nearby. He directed 12th Naval District officials to cast about for a replacement location, one that would be convenient to Alameda Island in the San Francisco Bay (where casualties from the war in the Pacific would be landed by ship and later plane), and capacious enough for a very large facility. McIntire’s agents hit upon the Oak Knoll Country Club, a luxurious facility that had gone bankrupt as a result of the Great Depression. Its facilities, including the lovely Club building, had lain fallow for several years. In April 1942, the government began the proceedings necessary to procure the property. The hospital received its first patients in August, and by the end of the war was caring for 3000 or more wounded and sick service personnel. The old Clubhouse was repurposed as the hospital Officers’ Club – a dining facility and watering hole for doctors, nurses and other officers serving in or visiting the facility and the Bay Area.

Oakland Naval Hospital, around 1945. Officers’ Club ? in lower right corner. Naval Hospital San Leandro , purpose-built to care for psychiatric casualties, is in the background.

The hospital flourished, especially after the Mare Island hospital closed in 1957. Its staff of doctors, nurses and corpsmen and corps waves cared for casualties of the Korean and Vietnam wars, and for legions of military family members and retirees. The “temporary” ward buildings you see in the image above were finally replaced with a new “Moderne”-style tower structure in 1968. Your correspondent drilled as a Reservist in one of those “temporary” buildings, in the 1980s. – Ed. The hospital closed in 1996 as part of the “BRAC”^ process that shuttered military bases and facilities all across the country.

Today, all that remains on the 160+ acre site is the Country Club / Officers’ Club. Developers had cleared the land by the early 2000s for a large housing area. At the time they expressed the intent of preserving the structure for use as a community center. This project came to a halt in 2008, a victim of the Great Recession. Now, developers are proceeding, but this time they express the intent to demolish the Club.

Naval Hospital Oakland Officers’ Club building, neglected. Next: demolition?

Facing the possibility that this lovely and historical structure may go away, a group of Oakland residents – Oakland Heritage Alliance – are mobilizing the forces to lobby Oakland city officials for its preservation, restoration and adaptive reuse. A piece of our historical patrimony hangs in the balance. Hearings are scheduled for some time this spring.

*U.S. Naval Hospitals numbered 19 at the outset of World War 2. One, at Cañacao in the Philippines, was lost early to the Japanese invasion. By the end of the war, the Navy was operating 99 hospitals. This number included country clubs, hotels, college dormitories “taken up from trade” or purchased outright (this is another story), and large, semi-permanent base, mobile and fleet hospitals located typically in “exotic” locations like Tutuila, American Samoa (e.g., Mobile Hospital No 3) or Hollandia, New Guinea (e.g., Base Hospital No 17).

^BRAC – [Defense] Base Realignment And Closure – the most recent in a long string of United States military base closures that began shortly after World War II. In all, something like 350 bases and installations went out of business in the five rounds (1988, 1991, 1993, 1995, 2005) of the BRAC process.

(C)2016 Thomas L Snyder, MD

Erosion of the Historical Landscape

“Fires Continue to Plague Historic Forts” is the headline in the most recent number (318) of Headquarters Heliogram, the Council on America’s Military Past newsletter. The article then details damage to structures at Fort Wayne (Indiana), Fort Niagara (upstate New York), and Fort Mifflin (near Philadelphia) over the past year. In my own backyard, the 6.0 American Canyon earthquake in August damaged several historic buildings – including the Museum and the main hospital structure – in the Mare Island Navy Yard historical area of northern California.  The Heliogram article closes: “Fires and vandalism [I’d add “nature and neglect”] seem to be a constant threat to historic sites. While some have around-the-clock security or alarm systems, many do not due to technical or financial challenges. Making repairs also costs money and many sites don’t have adequate insurance or reserves to cover the cost of [repairs of] damage.” City and other governmental agencies are often as dangerous to our history as “fires and vandalism”. My own city of Vallejo saw the wholesale destruction of historical structures – including a lovely and iconic Carnegie library – in its haste for urban renewal in the late 1960s.

Carnegie Exterior

Carnegie Library Vallejo CA. Opened 1904. Demolished 1969. Photo Courtesy Vallejo Naval and Historical Museum via http://www.carnegie-libraries.org/california/vallejo.html

Carnegie interior

Carnegie Library Vallejo CA. Interior. Image Courtesy Vallejo Naval and Historical Museum via http://www.carnegie-libraries.org/california/vallejo.html. Opened in 1904, it was demolished in an ill-advised flurry of downtown urban renewal in 1969.

 

And so we see that the inevitable result of the insults of time, nature, people and events – plus the lack of resources or interest to restore, preserve and protect them –  is the gradual degradation and disappearance of the most compelling records of our history – the physical evidence as represented by structures and landscapes.

So, what should historians – professional, academic and amateur – do?

First, of course, is to do what historians have always done: research and collect the information, write about it, analyze it, and make sure the historical structure, event, person, is made part of the historical record. While material published by traditional means – be it on stone, clay or paper – is pretty durable, especially if published in periodicals and books published by the hundreds or thousands, electronic publishing is problematic. Will the electronic format change? Will electronic storage “tanks” fall into disuse and neglect as time and technology move on? (The whole issue of archival storage is a topic for another day.)

Second, historians need to “sell” history to a public very interested in their past. Lectures given at libraries and museums are a natural. Lectures given to local service clubs like Rotary or Soroptimists deliver a message to community business and professional leaders, people with influence and money, people for whom “getting things done” is a way of life. Want to raise money or workers to restore a local icon? Get the Rotarians involved! Another way to deliver history to the public is by being a docent at a museum, park or historic site. Docents make history come alive by their enthusiastic and knowledgable story telling and explanations. My personal favorite is giving walking tours of historic sites; there’s something compelling about walking in the steps of the people who were part of the history you’re telling.

Third, historians need to become involved in the “politics” of restoration/reservation/protection. This may take the form of serving on the Commission that’s responsible for overseeing a community’s heritage or landmarks. Historians who give testimony or who advocate for preservation bring powerful and respected voices to any discussion about preserving our past. I know a local historian who quite literally single-handedly faced down developers and sympathetic local legislators to preserve a significant historic resource that was just weeks from being demolished for a construction project. (She gives credit to the historical society, but the reality is, she was one person – tenacious to be sure – who saved an important historical resource.) Public advocacy works!

Finally, historians can learn how to establish tax-exempt foundations to support preservation efforts of important resources. It’s easy to do – Nolo Press publish a handy go-by that really works. I know because I’ve set up three 501(c)(3) non-profits using their publication. Of course the non-profit corporation is just the first step. After that, you have to go out and beat the bushes for money. See steps two and three above. And recruit friends, colleagues and relatives to help out!

There you have it. Historians working to preserve our past by researching and publishing it, by selling it to a public hungry to know more, by advocating for restoration/preservation/protection at a local governmental level, and by raising funds for those efforts. No small order, but committed action does get results.

Tell us what you have done in your community. Give us your best ideas and best practices for restoring/preserving/protecting our past. Post your comments and I’ll make sure our readers see them.

©2014 Thomas L Snyder, MD

 

Whither the History of Medicine (Again…)

Last month, in an article entitled Offline: The moribund body of medical history, Lancet Editor-in-Chief Richard Horton opined that, since the 1980s, medical historians have lost the bubble on “important issues of the past as they might relate to the present.”  He declaims that the academics dominating the field have somehow forgotten that  the esteemed Owsei Temkin (a father of the study of medical history in the west) related the history of medicine to the social, cultural, political and economic milieu in which the art and science are practiced. Temkin, he says, felt that historians, more than mere toters-up of medical events, should interpret the ebbs and flows of this most human of human endeavors. Citing what he sees as a dearth of current relevant historical inquiry, Horton’s damning peroration is: “So where are the historians of today to illuminate the past as we struggle with the aggressive commercialisation of medicine, failures of professional leadership, notions of free will and death, misuse of medicines, paralysis in public health policy, or catastrophic failures of care? They appear to have evaporated, leaving a residue of dead and inert dust.”

University of Manchester medical historian Carsten Timmerman, replying in the Guardian blog The H Word, begged to differ. He lists several recent works that offer the kind of inquiry Horton despairs of seeing ever again, and points to his own bookshelf as proof. But here, Timmerman admits, may lie the problem. The books on his shelf are probably on the shelves of other medical historians, and that’s about all. He allows that there are so many historians of medicine now that they mostly content themselves by discussing the high topics of the day – with each other. So what Horton sees as a coffin may simply be an historical echo chamber!

Timmerman offers an answer to this problem of communication, and it’s one that will be familiar to readers of this blog: make your historical work relevant by talking to doctors and other health care givers. To this I would add, talk to the general populace by participating in the debate about social and medical policy through op-ed articles, letters to the editor, media interviews, and talks at your local Rotary club.

©2014 Thomas L Snyder, MD

A View of the People’s Liberation Army Navy (PLAN) Hospital Ship ”Peace Ark”

I’ve written about hospital ships before. Since then, I have privately wondered if there was a combat-casualty role for them in the modern world of sophisticated forward combat care hospitals and air transport to evacuate the most severe combat casualties to the highest levels of care. Moreover, big gray ships are increasingly being fitted out with sophisticated medical capabilities. In my posting on hospital ships, I mentioned the German Berlin-class Fleet Support Ship as an example. US amphibious ships, intended to provide support for Marine Corps operations, are all fitted out for surgery; the new USS America (LHA 6) will have expanded medical spaces in view with her capability to take on casualties by helicopter evacuation.(1) With this apparent move away from big white ships with big red crosses, whither hospital ships?

Peoples' Liberation Army Navy Hospital Ship "Peace Ark". Xinhoa Photo

People’s Liberation Army Navy Hospital Ship “Peace Ark”. (Xinhua Photo; Source: USNI News)

Enter the PLAN’s Peace Ark. This bwswbrc, the only Type 920 Hospital Ship in the Chinese inventory, possibly the only active PLAN hospital ship of any class, made a dramatic appearance at the recently concluded RIMPAC 2014 exercises. The Naval Institute news blog carried a nice article on the ship on 23 July.(2) Featured was Senior Captain Sun Tao, identified as the officer in charge of the ship’s medical detachment. Captain Sun told his interviewers that, when not under way, the ship carries a crew of 113 and a 20 person medical detachment. When at sea, the crew would increase to 300+ and the medical detachment to around 100.

While capable of receiving war casualties by helicopter, boat or high line, it appears that the ship has been used mainly for humanitarian / public affairs visits since it was first deployed beyond Chinese waters in 2010. Her most recent overseas activity was a humanitarian mission to the Philippines after super typhoon Haiyan.

The ship is fitted out with 8 operating rooms, 20 intensive care beds and 300 general care beds. Apparently, much of her medical gear is manufactured by the Dutch firm Phillips. She is equipped with an ultrasound suite, and CT and x-ray

Senior Captain Sun Demonstrates an Operating Room in PLAN Hospital Ship "Peace Ark" (Source: USNI News)

Senior Captain Sun Demonstrates an Operating Room in PLAN Hospital Ship “Peace Ark” (Source: USNI News)

capabilities. Interestingly, even her life boats are equipped to handle up to 18 stretchers or 24 ambulatory patients. Captain Sun showed off a gynecological examining room; this was a space, he said, that was particularly useful during humanitarian missions.

Given that navies of the world are apparently building ever more med-surg capability into big gray ships that are capable of protecting themselves against terrorist attacks, one is left wondering if hospital ships have any military utility at all. On the other hand, the dramatic good-will advertising power of a big white ship with big red crosses showing up in times of humanitarian need, makes the civilian utility of such vessels pretty obvious.

©2014 Thomas L Snyder, MD

(1) Defense Media Network Article “USS America (LHA 6) – a different kind of gator”, accessed 2014August06

(2) USNI News Article “Peace Ark: Onboard China’s Hospital Ship”, accessed 2014July24

On Reaching Age 70

In a 1905 speech marking his departure from the Johns Hopkins medical faculty, the revered William Osler offered that he had “two fixed ideas” about age. The first of these “is the comparative uselessness of men above forty years of age”, evidence for which, as he saw it, was the paucity “of human achievement in action, in science, in art, in literature -” arising from men above that age. He went on, “[t]he effective, moving, vitalizing work of the world is done between ages twenty-five and forty – these fifteen golden years of plenty, the anabolic or constructive period, in which there is always a balance in the mental bank and the credit is still good.”

Osler’s second fixed idea “is the uselessness of men above sixty years of age, and the incalculable benefit it would be in commercial, political, and in professional life if, as a matter of course, men stopped work at this age.” Osler quotes Donne stating that in ancient Rome, men at age sixty and beyond were denied the vote and were referred to as Depontani “because the way to the senate was per pontem [by way of the bridge], and they were not permitted to come thither.” He then cited – tongue firmly in cheek, I believe – Anthony Trollope’s novel “The Fixed Period” where that author advocates for “the admirable scheme of a college into which at sixty men retired for a year of contemplation before a peaceful departure by chloroform[!]“.

I retired – at Osler’s prescribed age 60 – from a very busy practice of urology. Part of my motivation was that the specialty was undergoing a sea change in surgical technique – to a much more laparoscope-based approach. I expected this would take me a good 3 or 4 years to master, just about in time to retire anyway. Better to make room for younger people brought up in the new surgical environment.

"The Astronomer" by Vermeer  (Credit: http://vermeer0708.wordpress.com/about/)
“The Astronomer” by Vermeer
(Credit: http://vermeer0708.wordpress.com/about/)

But no chloroform exit for me! In fact, enjoying a “comfortable” retirement has given me a sense of what it must have been like in 17th and 18th century Europe when men of means, who did not have to work for the next meal, could spend their mental energy immersed in artistic, literary or scientific endeavors. And thus it’s been for me in the intervening 10 years: I’ve researched and written some history and some commentary, In 2003, I founded the Society for the History of Navy Medicine to serve as a scholarly home for people interested in research, study and publication in the history of maritime medicine. For the last 2 years, I wrote a nearly weekly blog on various medical history topics (I just “retired” from these last two endeavors, on my 70th birthday). And then, there is “Community Involvement”: a Rotary club presidency, reorganizing the Fleet Admiral Nimitz Chapter of the Association of the United States Navy after decades of unconscionable silence; leadership in historical organizations both local and national; and recently, chairing a committee to establish a Poet Laureate program for my city.

One of the saddest things I observed in my practice were men whose lives essentially ended with retirement. With no “purpose” in life, these men descended into sometimes dreadful depressions. But for no reason! I believe that, in any community, all one has to do is let it be known that one is retired, and the phone will ring off the hook with offers of opportunity for community service. This is often joyful work, done alongside other people of good will who are doing it simply because they want to!

So, at age 70, at the beginning of the “third half” of my life, my calendar is “booked” right up through my 75th year. If I were to die tomorrow, I’d do so satisfied with a life well lived – but really pissed because there’s so much more I want to do!

This article was originally posted to my blog “Of Surgeons and the Sea” on 30 April 2013

©2013, 2014 Thomas L Snyder, MD

 

Of Ships and Surgeons Going “Private”

I started this blog when I was the Executive Director (Founding) of the Society for the History of Navy Medicine. I intended the blog to be the public voice of the Society, and so it was during my directorship of six years. When the Society’s next Director, Jim Dolbow took the helm, he created a blog specifically (and appropriately) for Society news and events. I suspect that the Society’s third Executive Director, Professor Annette Finley-Croswhite will expand the use of that site to get the Society’s word out. Given the firm establishment of the Society’s blog, I believe now’s a good time to take this blog, which is really my personal “historical” statement, “private”. Henceforth, the blog will be my personal means of communicating maritime medical history and commentary to the world.

After posting an article (typically of 400 – 600 words, and usually a researched historical piece) a week here for nearly two and a half years, my brain was pretty much sucked dry – I REALLY respect professional writers who must work to a weekly deadline for a whole career! – and the muse left me. But now, after a year’s sabbatical, I think it’s time to tiptoe back into the arena. Accordingly, I will post such occasional piece here, either history or commentary, as I am moved to produce. I hope you gain some benefit from these scriblings

The Blogger-in-Chief

(c) 2014 Thomas L Snyder, MD

Guest Blogger: Chaplain Dave Thompson on Non-Combat Casualties

Our blog-friend Chaplain Dave Thompson joins us for another post. This time, he writes about the matter of non-combat casualties of war since the Civil War.

As you are well aware, I have been trying to tell the story of disease in our wars…especially WW I ( The Great Flu Pandemic of 1918 in WW I), which cost more lives than combat in that conflict, For every American war before WW II, this largely was the case… death to disease trumped all combat deaths in these conflicts!.

In the Civil War a similar phenomenon of more deaths to disease than combat occurred (see: http://www.civilwarhome.com/casualties.htm ). Of the 618,000 soldiers who died in the Civil War, 2/3rd’s of them died of disease (414,152) and only 1/3 died in combat (204,070).

Then there were an additional 24,866 soldiers who died in prison due to disease and mistreatment as POW’s by both Union and Confederate forces!Outside of McKinley Kantor’s Pulitzer Prize Winning novel of a Confederate POW camp in SW Georgia,  Andersonville (see: http://www.amazon.com/Andersonville-Plume-MacKinlay-Kantor/dp/0452269563/ref=sr_1_1?s=books&ie=UTF8&qid=1362578878&sr=1-1&keywords=andersonville ), much of  the darker story of neglectful treatment of POW’s in the Civil War, on both the Union and Confederate sides, is rarely told today in general American History texts covering the 19th Century. See the Camp Sumter/Andersonville POW Prison story ( http://www.nps.gov/ande/historyculture/camp_sumter.htm ), where 45,000 union POW’s were imprisoned (see:http://www.nps.gov/ande/historyculture/camp_sumter.htm ), and where 13,000 died of a variety of diseases (see: http://www.nps.gov/ande/historyculture/causesofdeath.htm ).

Andersonville’s decrepit conditions were chronicled in the diary on P.O.W Newell Burch. Burch of the 154th New York Infantry, was captured the first day of the Battle of Gettysburg and imprisoned at Belle Isle and then Andersonville. He is credited with being the longest held Union Soldier during the Civil War, a total of 661 days in Confederate hands (usgwarchives.net). His diary is currently possessed by the Minnesota Historical Society.

The breakdown of casualties to disease and battles was quite interesting. Again, the stunning statistics of disease in war (over 66% of Civil War soldiers died in bed not in battle) that is often airbrushed out of our American histories, only telling the “glory” side of war.  More Civil War soldiers died of dysentery and diarrhea alone (way over 200,000) than were killed in all the battles and battlefields of the Civil War. Yet, you don’t see that kind of detail dealing with sickness in Civil War museum exhibits or re-enactments of battles…no field hospitals are built in rear areas in these re-enactments, nor any effort made to tell the general public the story of disease that accounted for the deaths of 2/3 of all the Civil War deaths in the Union and Confederate Armies. Many Americans are ignorant of this fact as we near the 150th Anniversary of the Civil War.

The “other war” against disease in conflicts is the kind of military history that is not talked about a lot in our “battle-centric” telling of war stories. Fundamentally, I sense, especially among military historians a problem in methods of historiography which focuses on battles as the easiest and most interesting things to report in a conflict, as well as an easy way to add up winners and losers by territory conquered or numbers killed (KIA) or  wounded (WIA). Meanwhile, lurking in the background are less jazzy statistics, like death dealing diseases in rear area cantonments, that cumulatively would trump the numbers of any combat casualties of a particular battle, campaign, or war.

Thus, we often ignore this larger background story of disease in war that dismally claims massive numbers of victims by a 2-1 margin in rear area field and general hospitals and POW camps, because it may have little to do with a 2 or 3 day battle like the Battle of Gettysburg. Unless a disease struck in the middle of a battle (like the 1918 Flu Pandemic did at the height of the Meuse Argonne Campaign in WW I, where General Pershing’s AEF was being decimated by this malady that made so many troops ineffective in  that battle), little is ever said in the course of a war about the role of disease in a war (except that written by medical historians and buried in medical record archives of the Army and Navy). Only in long Civil War sieges like that of Vicksburg or St. Petersburg, or the discovery of terrible health conditions in POW camps, would reports of sickness creep into a battle history, and then only in a sentence or paragraph of historical commentary, before getting back to what really was interesting…the movement of the chess pieces of armies and stories of bravery of solders, marines or sailors in combat.

Yet at the end of the war, when you add all the casualties related to cause of  death, we are shocked to discover the overwhelming numbers of those who lost their lives to disease…and a fair minded person asks, “where did that come from?” This big under-reported story of disease during the progress of a war is often ignored in our battle-centric focus of war reporting and military history inquiry, causing this “end of war statistic” to jump out at us after the war is over… but the military histories have already been written excluding this stark fact.

This dismal and boring aspect of disease in war largely goes under-reported in war…just like the story of logistics in war…the thousands of logistics ships and convoy escort ships that kept our forces going for four years to Europe and across the Pacific in WW II (a really big story of one of the main reasons we won WW II, which was lost in the historical glitter and clutter of reporting only 2 day to a week battles at sea…at Midway, Coral Sea, the “Slot” off of Guadalcanal, and Philippine Sea…or the terrible Pacific Island campaigns fought by sailors and marines that each took several weeks to a month per island). My eyes were opened to this little told “boring” logistical history, when I served on the USS Sacrament (AOE-1) that kept a whole aircraft carrier battle group going in beans, bullets/bombs and ship and jet fuel and supplies and mail  for a deployment in the Western Pacific and Indian Oceans (see: http://en.wikipedia.org/wiki/USS_Sacramento_%28AOE-1%29 ). Wars and combat operations would grind to a halt in weeks without this logistical tail working well. Rarely is that story told in our histories.

You are then struck with the challenge of historiography…how we select what we report on and what we ignore in our telling of military history. My sense is disease has not been given equal billing…or at least paid its due, in many of our American war chronicles of military history. It would make a great topic at a convention of military historians…and hopefully the presenter would not be thrown out of the presentation room for pressing for better reporting of this often lost story of the “other war” with disease that goes on in every one of our conflicts. The diseases change from war to war, but the challenge remains: Today we still face the danger of a variant of the 1918 flu pandemic bug getting away for us with CDC estimates of 100 million casualties…or “super drug resistant bugs” that can overwhelm a military hospital full of wounded military personnel and kill through infection many servicemen in record time.

As a former Navy Fleet Hospital Chaplain for a 500 bed combat zone fleet hospital,  I am impressed with this side of war that a lot of chaplains in military hospitals, as well as military doctors, nurses and medics/corpsmen, see with great regularity. It is not the glory side of war, but the gory side of war…with field and general hospitals filled with wounded warriors and service personnel stricken with all manner of death dealing diseases, soon forgotten as the battle moves on…and the story quickly moves on to the next battle or campaign.

The big lesson of history in our wars is the critical role our military medical departments play in dealing with wounds of war and infectious and debilitating diseases of the battlefield that can swallow large portions of armies and navies over the course of a war. It is a cautionary tale to military leaders not to neglect paying attention to disease in war that easily can kill more service personnel than any combat they may encounter. The record of history is clear that to ignore the medical aspect of military operations is to traverse into a deadly kill zone at one’s own peril with often devastating consequences. Only as we report this “other war” against disease and it becomes part of our military histories and learning from past conflicts, will we remain vigilant and prepared to fund and support efforts to deal with future medical challenges of disease on the battlefield.

Well, I have waxed long on the topic of disease getting better billing in our military histories. You are welcome to float this topic at a convention of military historians, but I am not sure what kind of reception you will receive. The “glory story of war” bias is alive and well among many military historians who see reporting diseases during wars as a distraction from what really is important in military history…reporting battles, campaigns and politics of war.

All I would hope would happen is an act of inclusion of reporting on disease among military historians…not exclusion …not diminishing the acts of valor or sacrifices of combat…but including better reporting of the role of disease in war in keeping with the scope and dimension of the problem… in the larger sphere of military history reporting.

©2013 David Thompson